Provider Demographics
NPI:1922200138
Name:PROHEALTH CHIROPRACTIC WELLNESS CENTERS, PA
Entity Type:Organization
Organization Name:PROHEALTH CHIROPRACTIC WELLNESS CENTERS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:YAGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:620-872-2310
Mailing Address - Street 1:110 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTT CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67871-1276
Mailing Address - Country:US
Mailing Address - Phone:620-872-2310
Mailing Address - Fax:620-872-7038
Practice Address - Street 1:2502 N JOHN ST
Practice Address - Street 2:SUITE B
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-2804
Practice Address - Country:US
Practice Address - Phone:620-271-0243
Practice Address - Fax:620-271-0218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0105109111N00000X, 111N00000X
KS01-05187111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS660194OtherBLUE CROSS BLUE SHIELD
KS660194OtherBLUE CROSS BLUE SHIELD